How do you prevent radiation induced colitis?

My primary strategy to prevent radiation-induced acute large bowel injury is to try to minimize the dose delivered to the bowel as much as possible. In patients who I think might be at high risk of developing this problem, I will give them written instructions about diet modifications (low fiber, low fat, reduce or avoid certain spices like capsaicin), but I generally do not ask them to modify their diet unless they start to develop symptoms. Similarly, if they are on a regimen for chronic constipation before treatment, I will recommend that they reduce doses or eliminate these agents entirely if symptoms develop. Usually, I will try modifying their anti-constipation regimen before imposing diet restrictions, since I find that patients are ...